Tracking #2007-00671
FA/P 8/3/07, eff. 10/1/07

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[I:/07053101.doc]

(12 CCR 2511-1)

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Re-write of Sections 11.100 through 11.400 were final adoption following publication at the 8/3/2007 State Board meeting, with an effective date of 10/1/2007 (Rule-Making# 07-5-31-1). Statement of Basis and Purpose and specific statutory authority for these revisions were incorporated by reference into the rule. These materials are available for review by the public during normal working hours at the Colorado Department of Human Services, State Board Administration.
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11.000  COLORADO STATE AND VETERANS NURSING HOMES
11.100  DEFINITIONS [Rev. eff. 10/1/07]
"Applicant" means the individual applying for residency in a State or Veterans Nursing Home, which includes the applicant’s legal representative.
"Colorado resident" means an individual who currently resides in Colorado, intends to reside in Colorado permanently and who does not maintain a primary residence in another state.
"Colorado State Veterans Center" means the State Veterans Nursing Home at Homelake and the Domiciliary at Homelake located in Monte Vista, Colorado.
"Legal representative" means an individual who has the legal authority to take a particular action on behalf of an applicant or resident.
"Medical leave" means absence of the resident from the Home due to admittance to a hospital or other institution as defined in the Department of Health Care Policy and Financing rules, Section 8.482.43 (10 CCR 2505-10).
"Surviving spouse" means a person who was married to a Veteran at the time of the Veteran's death, and who has not remarried or held himself or herself out to the public to be the spouse of another person.
"State Nursing Home (Home)" means any nursing home and/or related long term care program owned by the State of Colorado and operated by the Colorado Department of Human Services. 
"State Veterans Nursing Home" means any State Nursing Home or a nursing home administered under contractual obligation with a party that has been designed and constructed to qualify for federal funds and that is operated so as to qualify for per diem payments from the United States Department of Veterans Affairs.
"Veteran" means a person who served in the active military, naval, or air service, and who was discharged or released there from under conditions other than dishonorable.
11.110  RESIDENT ELIGIBILITY [Rev. eff. 10/1/07]
A.  An eligible resident in a State Veterans Nursing Home shall: 
1.  Be a Colorado resident Veteran; or, 
2.  Be a non-Colorado resident Veteran; or, 
3.  Be a spouse/surviving spouse of a Colorado resident or non-Colorado resident Veteran; or, 
4.  Be a surviving parent whose child(ren) who (all) died while serving in the armed forces of the United States; and, 
5.  Be able to be served safely by the reasonable and customary care provided in the State Veterans Nursing Home as determined by the Home’s admission staff in conjunction with any applicable state or federal law or regulation. 
B.  An eligible resident in a State Nursing Home shall be able to be served safely by the reasonable and customary care provided in the State Nursing Home as determined by the Home’s admission staff in conjunction with any applicable state or federal law or regulation.
11.120  ADMISSION PROCESS, WAIT LIST, AND PRIORITY [Rev. eff. 10/1/07]
A.  A person seeking admission to a State or Veterans Nursing Home may obtain an application form and information describing the application procedures from the individual Home. Staff shall provide the applicant with information regarding all required documentation, information and verifications necessary to complete the application when the application is requested. 
B.  Staff shall conduct a preadmission screening of the applicant to determine if the applicant meets the eligibility requirements stated in Section 11.110 within five business days of receipt of the application. If the requirements are met, the Home’s admissions staff shall review the submitted materials as outlined in Section 11.120, C. Once the applicant has been determined eligible, the applicant shall be admitted to the home or placed on the home’s wait list, if applicable.
C.  Applicants shall provide the following information: 
1.  A signed admission application, including completed financial information, a functional assessment, medical information and authorization for release of information; and,
2.  Verification of eligibility for admission, including proof of discharge from the armed services and a copy of the DD-214 Form, if applicable.
D.  In the event admission is denied, admission’s staff shall provide the applicant with information regarding their right to request a review of the denial and the review process. The applicant can request a review of the denial by sending a request in writing to the administrator of the home within thirty (30) calendar days of the date on the applicant's notice of denial. The administrator shall conduct a final review of the admission’s staff decision within ten calendar days of receipt from the applicant and shall notify the applicant in writing of the final decision. The decision of the administrator shall constitute final agency action.
E.  If a State or Veteran’s Nursing Home does not have a vacant bed for an approved admission, the applicant shall be placed on a wait list administered by each home. Wait list protocols shall be based on the following rank: 
1.  Date of completed application.
2.  Applicant is a resident Veteran.
3.  Applicant is a non-resident Veteran.
4.  Applicant is a spouse/surviving spouse.
5.  Applicant is a parent of a child(ren) who (all) died while serving in the United States Armed Forces. 
F.  An applicant on the wait list offered admission has ten business days from the date of the written notice of admission to accept or decline admission to the Home. If the applicant declines the offer of admission, the applicant’s name shall be removed from the list, unless the applicant requests to be moved to the bottom of the wait list.  If the applicant fails to respond to the offer of admission within ten business days from the date of the written notice, the applicant shall be moved to the bottom of the wait list. 
G.  The State or Veterans Nursing Home shall require all approved applicants to declare all sources and amounts of monthly income. Staff shall evaluate the financial status of an approved applicant to determine the person's ability to pay toward the cost of care and to calculate the maintenance rate. 
11.130  STATE OR VETERANS NURSING HOME RESPONSIBILITIES  [Rev. eff. 10/1/07]
A.  A resident shall be provided with the following information upon admission to a State or Veterans Nursing Home: 
1.  General information about the Home, resident care, services and activities available. 
2.  Resident Rights as found in Section 25-1-120, C.R.S.
3.  Grievance procedures per the Colorado Department of Public Health and Environment Regulations for long-term care facilities (6 CCR 1011-1).
4.  Other applicable Home policies including the Home’s rates, room reservation policy and charges.
B.  The Home’s staff shall review the above stated information with the resident or the resident's legal representative. After reviewing this information, the resident or resident's legal representative shall sign a statement indicating the they have received and reviewed the information and agrees to abide by the Home’s rules and regulations. This statement shall be kept with the resident's admission agreement. If changes occur to the information, the Home shall inform the resident and provide a copy of the changes. The resident or resident's legal representative shall sign a statement indicating they have received and reviewed a copy of the changes and agrees to abide by the changes.
11.140  ROOM RESERVATION CHARGES [Rev. eff. 10/1/07]
A.  The resident or the resident’s legal representative shall notify the Home twenty-four (24) hours in advance of any planned absences of over ten hours.
B.  A resident whose bed is held during an absence shall be responsible for any charges that accrued before or during the leave period.  If the resident or resident’s legal representative does not agree in writing to pay the reservation charge, the Home may reassign the resident’s bed to another resident or discharge the resident and place the resident on the Home’s wait list.
C.  There shall be no room reservation charge to a Medicaid resident on medical leave if no source of payment, other than the resident’s funds, are available and the Home’s current occupancy is less than ninety percent (90%) of capacity.
D.  Calculation of room reservation charges shall be as follows: 
1.  For non-Veteran Medicaid residents the room reservation charge shall be the Home’s current Medicaid per diem rate, less total food and linen service costs as computed from the most recent Med-13 Cost Report submitted to the Colorado Department of Health Care Policy and Financing (HCPF). In no case shall the charge be greater than the per diem rate less $2. 
2.  For Veteran Medicaid residents the room reservation charge shall be the Home’s current Medicaid per diem rate less total food and linen service costs as computed from the most recent Med-13 Cost Report submitted to the HCPF. In no case shall the charge be greater than the per diem rate less $2. If the resident is absent from the Home less than 96 hours, the current per diem rate provided by the U.S. Department of Veterans Affairs shall be subtracted from the room charge. 
Room reservation charges for a Veteran Medicaid resident, whose absence results in a loss of U.S. Department of Veterans Affairs per diem payment (greater than 96 hours), shall include the current per diem reimbursement provided by the U.S. Department of Veterans Affairs, retroactive to the resident’s date of departure.
3.  For private pay residents the room reservation charge shall be the Home’s private pay daily rate, less the daily total food and linen service costs as computed from the most recent Med-13 Cost Report submitted to HCPF. 
4.  Homelake Domiciliary residents shall be allowed thirty (30) days of approved leave per state fiscal year, excluding Medical Leave. Residents absent from the domiciliary over thirty days per fiscal year may be subject to discharge. The Homelake Domiciliary room reservation charge during any approved leave shall be the resident’s current daily rate at the time of leave. At the resident’s request, a domiciliary room shall be held for a resident admitted to the nursing Home for up to thirty days at the resident’s current daily rate. If the resident fails to return to the facility within thirty days, the resident shall be evaluated for continued stay at the domiciliary. If the resident is not approved for continued stay, the resident shall be given five business days to vacate the Homelake Domiciliary. The resident shall be responsible for the payment of rent through the day of departure.
E.  A bed may be held without charge for an approved applicant for up to two weeks from the date of acceptance of the offer of admission. Bed holds prior to admission may exceed two weeks from the date of acceptance with the approval of the Home’s administrator; however, the applicant shall be responsible for the daily rate following the first two weeks from the date of acceptance of the offer of admission.
11.150  FINANCIAL INFORMATION [Rev. eff. 10/1/07]
A.  An applicant or resident shall be the primary source of financial information to determine ability to pay except when management of the applicant's or resident's financial affairs has been designated to the legal representative. If the applicant or resident is not the source of financial information, the reason shall be noted in the financial information file.
B.  Residents shall apply for all federal and state benefits for which they may be eligible within thirty days of admission. The resident’s status with the home and eligibility for continued care shall not be affected if the resident is denied benefits. 
11.160  MAINTENANCE RATES – PAYMENT FOR CARE [Rev. eff. 10/1/07]
A.  Pursuant to Section 26-12-108, C.R.S., the Department shall establish rates for care of residents as nearly equal to the cost of operation and maintenance of the homes as practicable.
B.  Current rates shall be given to each applicant. Each home shall send a written notice of any increase in proposed rates to each resident no later than fourteen business days prior to the effective date of the new rate.
C.  Each Home shall have the authority to request pre-payment from a resident. 
11.170  PAST DUE ACCOUNTS [Rev. eff. 10/1/07]
A.  A resident's account shall be deemed past due if the debt has not been paid by the close of business on the due date. The due date is ten calendar days from the end of the month for which a resident resided at the home. Interest may be accrued on accounts which are thirty days past due, and may be referred to the State Controller for collection. 
B.  Discharge proceedings may be instituted per the Colorado Department of Public Health and Environment Regulations for long-term care facilities (6 CCR 1011-1) when an account is past due. Discharge proceedings shall be stopped if full payment is received by Home prior to the discharge taking place. 
11.200  BURIAL AT THE COLORADO STATE VETERANS CENTER [Rev. eff. 10/1/07]
A.  The following individuals are eligible for burial and interment at the Colorado State Veterans Center:
1.  A Veteran who at the time of his or her death was a Colorado resident.
2.  A Veteran’s spouse, surviving spouse; dependant parent, or child, including a minor child or an unmarried child who was physically or mentally disabled and incapable of self-support when such spouse, surviving spouse, or dependant parent was an occupant of the Colorado State Veterans Center at the time of death. 
B.  Documented proof of Veteran status or Veteran relationship shall be provided.
C.  All necessary expenses incidental to the burial and interment shall be paid from the estate of the decedent.
D.  Requests for burial and interment shall be made at least two business days prior to the funeral.
E.  Burial and interments shall be conducted Monday through Friday at noon.
F.  Site selection shall be at the discretion of the Colorado State Veterans Center.
G.  Only upright marble markers or headstones furnished by U.S. Department of Veterans Affairs shall be permitted.
11.300  LOCAL ADVISORY BOARD [Rev. eff. 10/1/07]
A.  Each State and Veterans Nursing Home shall institute a local advisory board. The local advisory board shall ensure appropriate communication channels are in place between the Home, the local community, and other stakeholder groups in order to resolve issues or celebrate successes at the earliest opportunity. 
B.  The local advisory board shall consist of a minimum five members, at least one of the members shall be a resident of the Home or a person who at the time of his or her appointment is a family member of a resident at the Home.
C.  The local advisory board shall submit a year-end report to the Office Director of the State and Veterans Nursing Homes by July 30 of each year beginning in 2008. The year-end report shall summarize board activities, member concerns, resident concerns, staffing vacancies, accomplishments and any other issues the board deems appropriate.
11.400  (NONE)
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